Secondary-progressive form of multiple sclerosis: MRI changes versus clinical status
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Updated: Jul 2, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Martin Masek1, Manuela Vaneckova, Jan Krasensky
1Department of Radiology, General Teaching Hospital, Prague, Czech Republic. martinmasek@centrum.cz
Objectives:
To monitor the interaction between the clinical manifestation of the secondary progressive form of multiple sclerosis (SPMS) expressed in the Expanded Disability Status Scale (EDSS) and abnormal findings in magnetic resonance imaging (MRI) of the brain. To compare a time line of brain atrophy in patients with SPMS, patients with relapsing-remitting multiple sclerosis (RRMS) and the healthy population.
Methods:
Brain atrophy, volume of increased signal lesions on Fluid Attenuated Inversion Recovery Sequence (FLAIR) sequence (s.c.lesion load) and decreased signal lesions on T1 weighted sequence (s.c. black holes) were measured semi-automatically and correlated with EDSS in 12 patients. Further, we compared a time line of brain parenchyma fraction (BPF) loss in patients with SPMS, patients with RRMS and the healthy population.
Results:
In patients with SPMS, no statistical correlation was found between lesion load in FLAIR and EDSS and there was also no significant statistical correlation (p=0.1134) between the volume of "black holes" and EDSS. However, we did confirm a significant correlation between increase in brain atrophy and clinical status (p=0.0093). Comparison of patients with SPMS or RRMS and the healthy population revealed that brain atrophy progressed most rapidly in patients with SPMS.
Conclusions:
The presence of a statistically significant difference in BPF loss between patients with SPMS or RRMS and the healthy population merits further study despite the small size of our sample. We postulate that the measurement of brain atrophy could be helpful in determining the transition of RRMS to SPMS and thereby predict the progression of the disease in the future.
Insights
Brain atrophy significantly correlates with clinical status in multiple sclerosis (MS). Patients with secondary progressive MS (SPMS) showed the most rapid brain atrophy compared to relapsing-remitting MS (RRMS) and healthy individuals.
Area of Science:
- Neuroimaging
- Neurology
- Medical Research
Background:
- Multiple Sclerosis (MS) is a chronic neurological disease.
- Secondary Progressive Multiple Sclerosis (SPMS) is an advanced form of MS.
- Understanding the progression of SPMS is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between clinical disability (Expanded Disability Status Scale - EDSS) and magnetic resonance imaging (MRI) findings in SPMS.
- To compare the rate of brain atrophy over time in patients with SPMS, relapsing-remitting MS (RRMS), and healthy controls.
Main Methods:
- Semi-automated measurement of brain atrophy, lesion load (FLAIR), and "black holes" (T1 lesions).
- Correlation analysis between MRI metrics and EDSS in 12 SPMS patients.
- Comparison of brain parenchyma fraction (BPF) loss trajectory in SPMS, RRMS, and healthy populations.
Main Results:
- No significant correlation was found between lesion load or "black holes" and EDSS in SPMS patients.
- A significant correlation was observed between increased brain atrophy and clinical status (p=0.0093).
- Brain atrophy progressed most rapidly in SPMS patients compared to RRMS patients and healthy controls.
Conclusions:
- Significant brain atrophy progression in SPMS and RRMS patients compared to healthy individuals warrants further investigation.
- Measuring brain atrophy may aid in identifying the transition from RRMS to SPMS.
- Brain atrophy assessment could potentially predict future disease progression in MS.
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